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Cardiac Arrythmias
Published in Charles Theisler, Adjuvant Medical Care, 2023
An arrythmia refers to any change from the normal sequence of electrical impulses that affects either the rate or rhythm of the heartbeat. Irregular heartbeats such as atrial fibrillation, bradycardia, tachycardia, conduction disorders, rhythm disorders, ventricular fibrillation, and premature contractions are arrythmias, also known as dysrhythmias. Palpitations are disturbances in the rhythm that can be felt and can make the heart feel like it is beating too hard or too fast, skipping a beat, or fluttering. Symptoms and signs of arrhythmia often include chest pain, dizziness, breathlessness, palpitations, fainting, chest fluttering, tachycardia or bradycardia, and shortness of breath. Arrythmia is the most common cause of sudden cardiac arrest. There are a wide variety of causes for arrythmias, such as myocardial infarction, coronary heart disease (CAD), hypertension (HTN), thyroid problems, drug abuse, diabetes, certain medications, etc. Smoking and excessive alcohol or caffeine use also increase the risk of an arrythmia.
Syncope
Published in Henry J. Woodford, Essential Geriatrics, 2022
Cardiac syncope is more likely when there is a history of cardiac disease, a family history of sudden death or in the presence of an abnormal ECG.52 Symptoms suggestive of a cardiac cause include preceding dyspnoea and onset during exertion (seeTable 15.5). Exercise results in peripheral vasodilatation and outflow tract impairment can prevent an appropriate increase in cardiac output resulting in syncope (but a vasovagal causation is more common shortly after finishing exercising). Alternatively, ischaemia-related ventricular tachycardia may be triggered. Cardiac syncope, unlike most neurocardiovascular syncope, is characteristically unrelated by either postural change or head movements and so should be suspected in individuals with symptom onset while sitting or lying still. A sensation of palpitations may be associated. Preceding shortness of breath is significantly more common with cardiac syncope, whereas prodromal autonomic symptoms of sweating, nausea, blurred vision or lightheadedness are more suggestive of non-cardiac syncope.53 A number of risk scores have been developed to try to accurately predict people with cardiac syncope and at a higher risk of adverse events.54 However, their role in the clinical evaluation of frail older people is unclear.
Common cardiac conditions, drugs and methods of assessment
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
A rise in dysrhythmias in pregnancy with reported palpitations is common and often non-threatening (see Electrical activity in the heart in Chapter 2). Palpitations may be due to sensitivity to oestrogen, anaemia, stress and anxiety, increased awareness of heartbeat due to the changing location of the heart within the chest, cold medicines, caffeine and cocaine. However, they may also be due to subclinical myocardial disease, especially in the last month of pregnancy. Assessment can be made via ambulatory Holter monitoring and an ECG. Treatment is according to the specific diagnosis.
Association of red blood cell distribution width with post-operative new-onset atrial fibrillation following cardiac valve replacement surgery: a retrospective study
Published in Biomarkers, 2022
Li Xin, Chu Chenghao, Hou Shuwen, Ge Shenglin, Zhang Chengxin
Preoperative laboratory and imaging examinations, intraoperative anaesthesia and surgical procedures [including sternotomy, establishment and weaning of cardiopulmonary bypass (CPB), valve replacement, cardiac incision suture, and closure of the thoracic cavity], and post-operative cardiac intensive care unit (CICU) management were performed in accordance with standard institutional practices. All patients were mechanically ventilated and monitored by five-lead electrocardiogram after admission to the CICU. The tracheal tube was removed when patients met the following criteria: (1) complete wakefulness; (2) stable hemodynamics; (3) satisfactory arterial blood gas analysis results; and (4) no excess bleeding. Patients were discharged from the CICU when their major vital signs were stable, and they were continuously monitored by telemetry in the regular ward for at least 3 days. In addition, ECG monitoring was used if patients had symptoms of palpitation, dyspnoea, and angina or arrhythmia.
Effect of menopausal symptom treatment options on palpitations: a systematic review
Published in Climacteric, 2022
Y. Sheng, J. S. Carpenter, C. D. Elomba, J. S. Alwine, M. Yue, C. X. Chen, J. E. Tisdale
This review contributes to future research and clinical practice in the field of palpitations. None of the reviewed articles used ECG devices to evaluate palpitations and exclude arrhythmias, such as atrial fibrillation. Several wearable ECG devices are approved as clinically diagnostic for accurately capturing heart rate and rhythm disturbances [82]. Future studies should use clinically diagnostic ECG devices to evaluate rhythm and rate disturbances occurring with the felt sensation of palpitations to better understand the symptoms and develop treatments. Clinicians should be aware that women reporting palpitations may need referral to a cardiologist to further evaluate the symptoms and any underlying arrhythmia, and to determine a best course of treatment. We note that, while beta-blockers effectively control the heart rhythm when used appropriately [83], there is scant evidence regarding their use for menopausal symptoms [55,84].
Clinical electrophysiology of the aging heart
Published in Expert Review of Cardiovascular Therapy, 2022
Kyle Murray, Muizz Wahid, Kannayiram Alagiakrishnan, Janek Senaratne
Palpitations are a heightened or uncomfortable awareness of heartbeat and are a common reason for elderly patients to present to a clinic or hospital [34]. Palpitations are divided into cardiac and noncardiac causes. Noncardiac causes are further subclassified into psychosomatic, medical illness, and pharmacologic mediated. Cardiac causes are secondary to arrhythmias (e.g. tachyarrhythmia, bradyarrhythmia, and extrasystoles) and structural heart disease (e.g. valvular disease, heart failure, and hypertrophic cardiomyopathy). In adults presenting to emergency with palpitations, 47% of cases are a cardiac cause [35]. Patients who are elderly, male, have irregular palpitations, palpitations lasting >5 minutes, and history of coronary artery disease (CAD) have a high likelihood of a cardiac cause [24].